From the Journals

Distinguish neurogenic from nonneurogenic orthostatic hypotension

 

Key clinical point: The ratio of change in heart rate (cHR) to change in systolic blood pressure (cSBP) was better than HR increase alone in distinguishing between neurogenic and nonneurogenic causes of orthostatic hypotension.

Major finding: A cHR/cSBP ratio of 0.492 bpm/mm Hg had the best sensitivity (91.3%) and specificity (88.4%) to distinguish neurogenic from nonneurogenic causes.

Study details: A prospective study including 444 adult patients with OH referred for autonomic evaluation to sites in the U.S. Autonomic Disorders Consortium.

Disclosures: The study authors reported no potential conflicts of interest.

Source: Norcliffe-Kaufmann L et al. Ann Neurol. 2018 Mar;83(3):522-31.


 

FROM ANNALS OF NEUROLOGY

In order to distinguish neurogenic from nonneurogenic causes of orthostatic hypotension, looking at the change in heart rate (cHR) in relation to the change in systolic blood pressure (cSBP) may be superior to looking at heart rate alone.

A cHR/cSBP ratio of 0.492 beats per minute (bpm)/mm Hg had the best sensitivity and specificity to distinguish neurogenic from nonneurogenic causes, according to results of a prospective study published in Annals of Neurology.

Dr. Lucy Norcliffe-Kaufmann, director of the Dysautonomia Center at NYU Langone Medical Center, New York

Dr. Lucy Norcliffe-Kaufmann

Patients with a ratio less than 0.5 might need additional screening for primary or secondary causes of autonomic failure, according to researcher Lucy Norcliffe-Kaufmann, PhD, associate director of the Dysautonomia Center at NYU Langone Medical Center, New York.

“If you just look at the heart rate increase alone, of course it is blunted, but it doesn’t really give you the bigger picture that you get when you look at the heart rate in relation to the blood pressure fall,” Dr. Norcliffe-Kaufmann said in an interview.

Neurogenic orthostatic hypotension, which indicates an underlying pathology affecting autonomic neurons, has a much worse prognosis than does nonneurogenic orthostatic hypotension, according to Dr. Norcliffe-Kaufmann and her colleagues, who published the results on behalf of the Autonomic Disorders Consortium.

One key difference between the two groups, they added, is that patients with neurogenic orthostatic hypotension typically have little or no heart rate (HR) increase in the upright position, while patients with nonneurogenic orthostatic hypotension may have marked tachycardia.

Despite the importance of orthostatic HR changes in differential diagnosis, however, there has been no systematic evaluation of HR ranges that may be diagnostic, and proposed ranges have been based on expert clinical experience rather than clinical data, they said.

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